New guidance: take medication and operate early for childhood obesity

The longstanding practice of “watchful waiting” or delaying treatment to see if children outgrow or overcome obesity on their own only exacerbates the problem.

WASHINGTON. Children battling obesity should be screened and treated early and aggressively, including with medication for children as young as 12 and surgery for children as young as 13, under new guidelines released on Monday.

The longstanding practice of “waiting” or delaying treatment to see if children and teens outgrow obesity or overcome it on their own only exacerbates the problem that affects more than 14.4 million young people in the US. Left untreated, obesity can lead to lifelong health problems. including high blood pressure, diabetes and depression.

“Waiting doesn’t work,” says Dr. Ihuoma Eneli, co-author of the American Academy of Pediatrics’ first childhood obesity guide in 15 years. “What we are seeing is continued weight gain and the likelihood that I will have them (obese) as an adult.”

For the first time, the group’s leadership is setting the age at which children and teens should be offered medical treatments such as medications and surgery, in addition to intensive diets, exercise and other behavioral and lifestyle interventions, said Eneli, director of the Healthy Lifestyle Center. Weight and nutrition at the National Children’s Hospital.

As a general rule, clinicians should offer obese adolescents 12 years of age and older access to appropriate medications, and severely obese adolescents 13 years of age and older a referral for weight loss surgery, although situations may vary.

The guide aims to shed the misconception about obesity as “a personal issue, perhaps a lack of diligence,” said Dr. Sandra Hassink, medical director of the AAP Healthy Childhood Weights Institute and co-author of the guide. .

“It’s no different than if you have asthma and now we have an inhaler for you,” Hassink said.

Young people whose body mass index meets or exceeds the 95th percentile for children of the same age and gender are considered obese. Children who reach or exceed the 120th percentile are considered severely obese. BMI is a measure of body size based on a calculation of height and weight.

According to the Centers for Disease Control and Prevention, nearly 20% of children and adolescents in the United States and about 42% of adults are obese.

The group’s guidance recognizes that obesity is a biological problem and that the condition is a complex chronic disease, said Aaron Kelly, co-director of the Obesity Pediatric Medicine Center at the University of Minnesota.

“Obesity is not a lifestyle issue. It is not a lifestyle disease,” he said. “It predominantly arises due to biological factors.”

The guidance comes in the wake of the emergence of new drugs to treat childhood obesity, including the approval late last month of a weekly injection of Wegovy for children aged 12 years and older. Different doses of a drug called semaglutide are also used under different names to treat diabetes. A recent study published in the New England Journal of Medicine found that Wegovy, created by Novo Nordisk, helped teens lower their BMI by an average of about 16%, better than adults.

A few days after the Dec. 23 clearance, pediatrician Dr. Claudia Fox prescribed the drug to one of her patients, a 12-year-old girl.

“What it offers patients is the ability to have a near-normal body mass index,” said Fox, also a weight management specialist at the University of Minnesota. “It’s a completely different level of improvement.”

The drug affects how pathways between the brain and the gut regulate energy, said Dr. Justin Ryder, an obesity researcher at the Lurie Children’s Hospital in Chicago.

“It works on how your brain and stomach communicate with each other and helps you feel fuller than you might otherwise be,” he said.

However, certain doses of semaglutide and other anti-obesity drugs have been difficult to obtain due to recent shortages caused by manufacturing issues and high demand, fueled in part by celebrities on TikTok and other social media platforms boasting about accelerated weight loss.

Also, many insurers won’t pay for drugs that cost about $1,300 a month. “I submitted the prescription yesterday,” Fox said. “I have no doubt the insurance will cover it.”

One expert on pediatric obesity has warned that while obese children need to be treated early and intensively, he fears some doctors may turn too quickly to drugs or surgery.

“It’s not that I’m against drugs,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I am against willy-nilly using these drugs without addressing the cause of the problem.”

Lustig said children need to be assessed individually to understand all the factors that contribute to obesity. He has long blamed too much sugar for the rise in obesity. He urges to pay special attention to the diet, especially ultra-processed foods that are high in sugar and low in fiber.

Dr. Stephanie Byrne, a pediatrician at Cedars Sinai Medical Center in Los Angeles, said she would like to do more research on the drug’s effectiveness in a more diverse group of children and potential long-term effects before she starts prescribing it regularly.

“I would like it to be used on a more consistent basis,” she said. “And I would have to have this patient come in quite often for observation.”

At the same time, she welcomed the group’s new emphasis on the rapid and intensive treatment of childhood obesity.

“I definitely think it’s the realization that diet and exercise isn’t going to help some of the teens who are struggling with it — maybe the majority,” she said.

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